tbuckley/cabot-search huggingface dataset:
Abstract 12019: Educational Attainment is Associated With Cardiac Rehabilitation Enrollment
Authors: Yimin Chen, Joshua Garfein, Gretchen Swabe, Jared W Magnani
Journal: Circulation (2022)

Introduction: Cardiac rehabilitation (CR) remains significantly underutilized. We examined the association of educational attainment (EA) with CR enrollment in a health claims database, hypothesizing that individuals with lower EA would be less likely to participate in CR. Methods: We employed an administrative database (Optum de-identified Clinformatics® Data Mart) to select individuals with incident events indicating CR eligibility from 2016-2018. We collected demographics (age, sex, race and ethnicity); comorbid conditions (hypertension, diabetes, stroke and those defined by the Elixhauser Comorbidity Index); household income; and CR qualifying event. In multivariable-adjusted logistic regression, we related EA (≤high school diploma; &gt;high school diploma and &lt;bachelor’s degree; ≥bachelor’s degree) to CR enrollment. We examined the association of EA and CR enrollment by race or ethnicity strata. Results: In 121,598 individuals eligible for CR, those with lower EA had lower odds of CR participation. Individuals with ≤high school diploma had 39% lower odds (95% Confidence Interval [CI] (35-42%) of enrolling in CR compared to those with ≥bachelor’s degree. The association of lower odds of CR enrollment with lower levels of EA persisted across racial and ethnic strata ( Figure ). Black individuals with ≥bachelor’s degree had similar odds of CR enrollment as White individuals with the same level of education (Odds Ratio [OR] 0.95, 95% CI 0.77-1.17). Hispanic (OR 0.26, 95% CI 0.23-0.28) and Asian individuals with ≤high school diploma (OR 0.25, 95% CI 0.19-0.33) had the lowest odds of CR enrollment compared with White individuals with ≥bachelor’s degree. Conclusions: We identified associations between EA and CR enrollment persisting across racial and ethnic strata. Our findings support increased attention to individuals with limited education to improve CR enrollment.
Abstract 11296: Non-Invasive Assessment of Liver Stiffness in Pulmonary Hypertension Patients - A New Marker for Right Ventricular Dysfunction
Authors: ELIAURIA R MARTINS, Marcelo Melo, Luis Fabio Botelho, Jose Eymard Moraes de Filho, Agostinho Neto, Fernando Bacal
Journal: Circulation (2022)

INTRODUCTION - Right ventricular dysfunction (RVD) is an important indicator of a poor Pulmonary Hypertension (PH) prognosis. Cardio-hepatic interaction in left heart failure (LHF) is discreet, however, research is lacking in right heart failure (RHF). The study rationale is that PH patients can evolve to RHF with increased pressure in right chambers and passive hepatic congestion, consequently leading to an increase in liver stiffness (LS). OBJECTIVE - Assess LS in precapillary patients compared to a healthy control group. METHODOLOGY - A transversal pilot study conducted from January 2020 to April 2022 with precapillary PH patients over age 18, diagnosed by right heart catheterization. Postcapillary PH secondary to schistosomiasis, liver disease and alcoholism were excluded. Results were paired with a healthy control group. Both groups underwent two-dimensional speckle tracking with strain echocardiogram (ECO) and shear wave hepatic elastography (HE) on a Phillips ultrasound. HE measurements were taken at two points; standard (SHE), supported by literature and widely used, and a central (CHE), located near the hepatic thread. In addition, the PH group underwent laboratory exams: liver function, BNP dose, complete blood count and kidney function. Results: PH group 31 patients: 26 women (84%) and 5 men (16%); average age 51.7 (24-81 years). PH group etiology: group I (63%), group IV (22.6%) and group III (16%). Degree of dyspnea: III (74%), II (16%) and I (6%). Control group 15 individuals: 10 women (67%) and 5 men (33%): 45.7 average age (27-61 years). PH group SHE median 5.93Kpa, IQR: 5.87, versus 3.69kpa for the control group (p&lt;0.001) with IQR 0.82kpa. While PH group CHE was 8.03Kpa: IQR 6.10Kpa (p&lt;0,001) versus 5.15Kpa, IQR 1.60Kpa in the control group. ECO parameters in PH patients, only the right ventricle free wall strain presented a moderate correlation with SHE, Pearson coefficient of -0.427 p&lt;0.019. There is a high correlation between SHE and CHE, Pearson coefficient 0.887 p&lt;0.001. PH group lab results did not indicate correlation with ECO nor HE. CONCLUSION: HE can be used as a new marker for RVD in PH patients.
Abstract 11644: The Role of Neutrophil Extracellular Traps in Models of Diabetic Vascular Dysfunction
Authors: Chao Liu, Kevin B Atkins, Srilakshmi Yalavarthi, lixia zeng, Christine E Rysenga, Nikoo Alizadeh, Subramaniam PENNATHUR, Jason S Knight
Journal: Circulation (2022)

Aim: NETosis is a type of neutrophil cell death that results in the release of pro-inflammatory neutrophil extracellular traps (NETs). While NETs contribute to some diabetes-associated complications such as dysfunctional wound healing, their potential role in diabetic vascular dysfunction has not been studied. To investigate this possibility, we utilized knockout mice ( Elane -/- and Pad4 -/- ) deficient in NETosis through loss of neutrophil elastase and peptidylarginine deiminase 4, respectively. Methods and Results: Akita mice develop hypoinsulinemia and hyperglycemia by 4 weeks of age. Akita mice were crossed separately with Elane -/- and Pad4 -/- mice to generate NETosis-deficient diabetic mice. Endothelium-dependent vasodilation was assessed in the aortae of the following strains by wire myography (n=10-15/group): wild-type (WT), Akita, Akita- Elane -/- , and Akita- Pad4 -/- . By 24 weeks of age, Akita mice demonstrated consistent impairment of acetylcholine-mediated relaxation (Akita E max =54.1% ± 1.8 and WT=80.6% ± 1.8; p&lt;0.0001). As compared with Akita mice, both Akita- Elane -/- mice (E max =75.1% ± 1.7; p&lt;0.0001) and Akita- Pad4 -/- mice (E max =70.2% ± 1.5; p&lt;0.0001) demonstrated superior relaxation. Furthermore, transfer of neutrophils from aged Akita mice into young WT mice rapidly triggered impaired acetylcholine-mediated relaxation (p&lt;0.0001). Prostanoid metabolites were measured in aortae of 24-week-old mice. TXB 2 (a surrogate for TXA 2 ) was 5-fold higher in both intact and denuded aortae of Akita mice as compared with WT mice (p&lt;0.01); Akita- Elane -/- and Akita- Pad4 -/- mice had TXB 2 levels near WT. Interestingly, 15-deoxy-Δ12,14-PGJ 2 (a dehydration product of PGD 2 and potent PPARγ agonist) was upregulated 10-fold (p&lt;0.001) in Akita endothelium, suggesting an attempted compensatory mechanism. Conclusion: Inhibition of NETosis largely prevented the development of vascular dysfunction in diabetic mice. Thromboxane was strongly upregulated in the vessel walls of NETosis-competent diabetic mice suggesting a role for neutrophils in driving the production of this vasoconstrictive and atherogenic prostanoid. NETosis may represent a novel target for prevention of diabetic complications including vascular dysfunction.
Abstract 12107: Short-Term and De-Escalation Dual Antiplatelet Therapy for Patients With Acute Coronary Syndrome: A Systematic Review and Network Meta-Analysis
Authors: Toshiki Kuno, Atsuyuki Watanabe, Satoshi Shoji, Tomohiro Fujisaki, Hisato Takagi, Pierre Deharo, Thomas Cuisset, Shun Kohsaka, Deepak L Bhatt
Journal: Circulation (2022)

Background: Short-term (&lt;6 month) or de-escalation (e.g. switching potent P2Y 12 inhibitors to less potent/lower-dose agents a month after the event) dual antiplatelet therapy (DAPT) have become an attractive therapeutic strategy for patients with acute coronary syndrome (ACS). However, these strategies have never been randomly compared. Methods: PubMed, EMBASE, and Cochrane Central were searched in April 2022. Randomized controlled trials (RCTs) or their subgroup analyses that included ACS patients, with standard (12 months), extended (≥18 months), short-term and unguided de-escalation DAPT strategy, along with the guided DAPT strategy with genotype or platelet function tests were identified. The efficacy outcome (major adverse cardiovascular events: MACE) was defined as a composite of cardiovascular death, myocardial infarction, or stroke. The safety outcomes were mainly defined as major or minor bleeding, and major bleeding. Results: This network meta-analysis included 32 RCTs with 103,497 patients. While there was no significant difference in efficacy among the short DAPT, unguided de-escalation and guided-selection strategy, the unguided de-escalation strategy alone was associated with reduced risks of MACE compared with standard DAPT (e.g. versus DAPT with clopidogrel; HR [95% CI]: 0.66 [0.48-0.91]). Both the short DAPT and de-escalation strategies were associated with reduced risks of major or minor bleeding compared with other strategies including the guided-selection (HR [95% CI]: 0.66 [0.47-0.93], 0.48 [0.33-0.71], respectively); the short DAPT strategy alone was associated with a reduced risk of major bleeding compared with standard, extended and guided-selection DAPT (HR [95%CI]: 0.55 [0.33-0.92]). Conclusions: In ACS patients, the unguided de-escalation strategy was associated with reduced risks of MACE, while the short DAPT strategy was associated with decreased rates of major bleeding compared with standard DAPT, suggesting both strategies can be used in select patients by balancing patients’ ischemic and bleeding risks.
Abstract 116: Regulation Of Nampt Secretion From Human Neutrophils By The Trpv2 Channel
Authors: Xiangdong Zhu, Jing Li, Shaoxia Lin, CODY JUSTICE, Terry L Vanden Hoek
Journal: Circulation (2022)

Introduction: Nampt functions both as an intracellular enzyme critical for NAD + salvage and a novel extracellular damage-associated molecular pattern. In a mouse model of cardiac arrest, increased plasma Nampt correlates with inflammation, cardiovascular dysfunction and death. The mechanism that regulates Nampt secretion during cardiac arrest is not known. Hypothesis: We hypothesize that Nampt secretion is regulated by a non-selective cation channel TRPV2. Methods: Extracellular Nampt (eNampt) concentration was measured by ELISA. Neutrophils were isolated from human peripheral blood. Results: In non-stimulated human neutrophils incubated at 37 o C, eNampt was observed in cell supernatants at 10 min and plateaued after 30 min. eNampt is not released by the ER-Golgi classical pathway. Brefeldin A, an inhibitor of protein transport from ER to Golgi had no effect on eNampt release. Similarly, nocodazole, which disrupts microtubule assembly, had no effect on eNampt release either. eNampt release was markedly reduced at 4 o C, suggesting that the release is active. eNampt release was regulated by extracellular pH. The decline in pH from 7.4 to 6.5 suppressed the secretion of eNampt, while the increase of pH from 7.4 to 7.8 enhanced the amounts of eNampt release. We therefore reasoned that ion channels sensitive to pH and/or involved in intracellular pH homeostasis might play a role in Nampt secretion. 10 μM 5-(N,N-Hexamethylene) amiloride had no effect on eNampt release, which indicates that Na + /H + exchanger is not involved in eNampt release. In contrast, eNampt release was upregulated by the TRPV2 agonists 200 μM H 2 O 2 , 1 mM 2-aminoethoxydiphenyl borate and10 μM anandamide, and downregulated byTRPV2 inhibitors 0.5 mM EGTA, 5 mM NAM, 100 μM tranilast and 100 μM piperlongumine. Conclusion: Nampt is secreted from neutrophils via a non-classical pathway and its secretion is regulated by the pH sensitive TRPV2 channel.
Abstract 12331: Prospective Evaluation of Risks Ventricular Arrhythmia Ablation With Half Normal Saline Irrigation
Authors: Kanae Hasegawa, Zachary T Yoneda, Kenichi Tokutake, Travis D Richardson, Montgomery A Jay, Sharon T Shen, JC Estrada, Saavedra J Pablo, Amy Emerson, Marilyn L Walker, Gregory F Michaud, Arvindh N KANAGASUNDRAM, William G Stevenson
Journal: Circulation (2022)

Background: Failure of radiofrequency ablation (RFA) of ventricular arrhythmias (VA) is often due to inadequate lesion size. RFA with half-normal saline (HNS) irrigation has the potential to increase lesion size, but can increase steam pops, which could increase risks of perforation and emboli. Optimal energy titration is not defined. Objective: To assess peri-procedural complications of ventricular arrhythmia (VA) ablation with HNS RFA guided by impedance monitoring and intracardiac ultrasound (ICE). Methods: All patients undergoing endocardial RFA only for VA from October 2018 to September 2021 were prospectively assessed for complications in hospital and at 30 days by clinic visit or phone call. Of 862 procedures 616 patients undergoing 663 endocardial RFA were included. HNS or normal saline (NS) RF irrigation and were selected at the discretion of the physician. RFA power was titrated to a &lt; 15 Ohm impedance fall with intracardiac ultrasound monitoring for tissue whitening and increasing bubble formation in most cases. Results: Of 663 procedures HNS was used in 552 (83%) and NS in 111 (17%). The HNS group was older, with more heart disease, ventricular tachycardia, LV ablation sites, and RFA time. There were 59 complications (8.9%) in 53 procedures, including 11 pericardial effusions (1.6%) (2 requiring surgical repair), and 2 strokes (0.3%). There was no significant difference between HNS and HS in complications or mortality (table). Conclusion: HNS irrigation ablation with power guided by impedance fall and ICE is associated with a low incidence of serious complications. A small difference can not be excluded, but would require a very large trial and seems unlikely to be clinically relevant.
Abstract 11762: Increased Body Mass Index/Obesity is Associated With Higher Mortality and Major Adverse Cardiac Events in Patients With Hypertrophic Obstructive Cardiomyopathy (HOCM) on a Long-Term Follow-Up - A Systematic Review and Meta-Analysis
Authors: Samuel Edusa, Aditya Sharma, Rabia Naseem, Yash R Patel, Gurmannat SIngh Kang, Ibadat Anmol Singh, Shilpa Reddy, Nafisa Reyaz, Aakash Desai, Sonal Devi Duggirala, SAMIR STANIKZAI, Dharshana Prem Anand, Rupak Desai
Journal: Circulation (2022)

Background: Considering a paucity of pooled data on the influence of Body Mass Index (BMI) on long-term cardiac outcomes in individuals with Hypertrophic Obstructive Cardiomyopathy(HOCM), we conducted this systematic review. Methods: PUBMED, Scopus, EMBASE and Google Scholar were used to screen studies reporting Mortality/Major Adverse Cardiac Events (MACE) and Sudden Cardiac Death(SCD) among obese vs nonobese HOCM patients. Pooled odds ratios(OR) and heterogeneity were assessed with random-effects models and I 2 statistics. Subgroup analysis was performed to assess the risk by study type, sample size, country and procedure. The leave-one-study-out method was used for sensitivity analysis. Results: Of the 178 titles screened, we included 13 studies published between 2016-2022 with a total of 2,409,397 HOCM patients followed for a median of 6 years (1.8-8.2 year range). The sample had a higher proportion of males (61.33%) with a mean age of 56.3 years (37-78 year range). The unadjusted [OR=1.55(1.09-2.21), I 2 =96%] and adjusted [OR=1.28 (1.06-1.54), I 2 =82.7%] pooled odds of all-cause mortality were significantly higher with increased BMI. On subgroup analyses, prospective studies showed higher odds [n=3, 1.79 (1.23-2.6), p&lt;0.01] vs. retrospective ones [n=10, OR=1.2(0.99-1.46), p=0.06]. US Studies, which had large sample sizes, had higher odds [n&gt;=1000:OR=1.39(1.24-1.57)] but lower sample sizes from other countries [n&lt;1000] failed to show statistical significance. The odds of MACE increased with higher BMI [OR=4.27(3.50-5.21), p&lt;0.01], without a significant impact on the risk of SCD [p=0.10]. In those who underwent septal myectomy, increased BMI was associated with higher post-procedural all-cause mortality [OR=1.12(1.02-1.22), p=0.01]. Conclusions: A higher BMI/obesity in HOCM is associated with increased all-cause mortality, MACE and mortality after septal myectomy on a long-term follow-up (&gt;5 years), without an association with SCD risk.
Abstract 11537: IGF-1 Reduces Atherosclerosis in Rapacz Pigs
Authors: sergiy sukhanov, Yusuke Higashi, Svitlana Danchuk, Mitzi Alfortish, Traci Goodchild, Amy Scarborough, Thomas E Sharp, DANIEL C GARCIA, James S Jenkins, Jeffrey Schumacher, Jan Ivey, Darla Tharp, Douglas K Bowles, David J Lefer, Patrice Delafontaine
Journal: Circulation (2022)

Introduction: Cardiovascular disease, including atherosclerosis is the leading cause of mortality in the Western world. We have reported that insulin-like growth factor I (IGF-1) reduced atherosclerosis in the murine model, however it is unknown whether IGF-1 exerts protective effect on human-like atherosclerosis. Hypothesis: Rapacz pigs with familial hypercholesterolemia (FH pigs) fed with high-cholesterol diet develop human-like advanced plaques in coronary arteries. We hypothesize that IGF-1 suppresses atherosclerosis in FH pigs. Methods: Human recombinant IGF-1 ( 50 ug/kg) or saline (control) was injected daily into high-fat diet fed FH swine (n=9/group) for 6 months. Atherosclerotic burden was quantified by intravascular ultrasound (IVUS) at basal level (T0), after 3 months on diet (T3) and at sacrificing (T6). Results: IGF-1-injected pigs had 2.6-fold increase in total plasma IGF-1 (ELISA, p&lt;0.001 vs. control pigs). Pigs in IGF-1 and control groups had a gradual increase in vessel volume in the right coronary artery (RCA), and left anterior descending artery (LAD) with time as quantified by IVUS. However, IGF-1-injected pigs had a larger increase in vessel volume after 3 and 6 months compared to controls suggesting vascular hypertrophy. The atherosclerotic burden was increased in RCA, and LAD in both groups after 3 and 6 months of injections compared to the pre-injection time point. We found a significant reduction in atherosclerotic burden in RCA and LAD in IGF-1 group compared to control at 6 months’ time-point (RCA: IGF-1, 203±13%, vs. control, 244±8; LAD: IGF-1, 200±6%, vs. control, 228±11%). The lumen volume of coronaries was decreased in both groups, however, coronaries in IGF-1-injected pigs had on average 24±3% larger lumen volume compared to control pigs at 6 months’ time-point. Conclusions: We found that IGF-1 increased total volume of pig coronaries suggesting hypertrophy and these data are consistent with growth-stimulating effects of IGF-1. We found reduction in atherosclerotic burden and increase in lumen volume in coronaries in the IGF-1 group after 6 months of injections consistent with an anti-atherosclerotic effect of IGF-1. Our data support the feasibility of using IGF-1 for as an anti-atherogenic therapy.
Abstract 12105: Sudden Death Associated With Pregnancy
Authors: Audrey Uy-Evanado, Arayik S Sargsyan, Chad Sorenson, Harpriya Chugh, Sean Hurst, Kyndaron Reinier, Sumeet S Chugh
Journal: Circulation (2022)

Introduction: Sudden and unexpected deaths associated with pregnancy are rare but devastating occurrences in society. There is a significant lack of prospective, population-based data in the US regarding etiologies and clinical manifestation. Hypothesis: Prospective community-wide analyses can inform the assessment of burden as well as prevention strategies for sudden deaths associated with pregnancy. Methods: From the ongoing prospective, Oregon Sudden Unexpected Death Study (ORSUDS, Portland OR catchment pop. 1 M, 2002-2021) and the Prediction of Sudden Death in Multi-Ethnic Communities (PRESTO, Ventura CA catchment pop 850K, 2015-2021), we performed a detailed evaluation of all sudden death cases that occurred within 1 year of pregnancy; including lifetime clinical history, SCA presentation and resuscitation outcome. Results: A total of 381 (46 in PRESTO and 335 in ORSUDS) sudden deaths occurred in females aged 15 to 49 years, and 17 of these (4.5%) occurred within a year of pregnancy. Pregnancy-related cases were between 21 and 39 years of age and included 7 non-Hispanic whites, 5 Hispanic/Latinos, 1 black, 1 Native American and 3 subjects of unknown race/ethnicity. Sudden cardiac arrest occurred while pregnant (6), during delivery (2), within 3 months post-partum (5) and a miscarriage (1), and between 3 and 9 months post-delivery (3). Only witnessed cases survived (4/17, 24%) and presented with both shockable rhythm (2) and non-shockable rhythm (2). Presumptive cause of death included 10 cardiac etiologies including presumed sudden arrhythmic death (4), coronary artery disease (2), left ventricular hypertrophy (1), severe mitral valve prolapse (1), myocardial fibrosis (1) and long QT syndrome (1). Non cardiac causes included drug overdose (2), obstetric thrombo-embolism (2), cerebro-vascular accident (2), and status asthmaticus (1). Conclusions: Our findings suggest that pre-existing heart disease is likely to be the most important risk factor for sudden unexpected death associated with pregnancy, and warrants further detailed investigation.
Abstract 12077: Impact of Overweight and Obesity on Left Ventricular Structure and Function in a Community Dwelling Cohort Free of Cardiovascular Disease
Authors: Saadia Qazi, Philimon N Gona, Jane J Lee, Connie Tsao, Carol Salton, Christopher ODonnell, Warren J Manning, Michael L Chuang
Journal: Circulation (2022)

Introduction: Obesity is associated with excess cardiovascular morbidity and mortality as well as structural and functional differences in left ventricular (LV) mass (LVM), end-diastolic volume (LVEDV), and stroke volume despite indexation. Hypothesis: We hypothesize that overweight and obesity impact LV structure and function in a healthy community dwelling cohort. Methods: Framingham Offspring study participants (N=678, 62%F; 65±9y) free of any history of hypertension, myocardial infarction, heart failure, or CMR wall-motion abnormality and underwent bSSFP CMR at 1.5T. They were stratified by sex and body mass index (BMI) category (normal weight =18.5 to 24.9; overweight =25.0 to 29.9; obese ≥30 kg/m 2 ). LVM was measured from contiguous short-axis images, then indexed to height (HT, m), body surface area (BSA, m 2 ), and weight (WT, kg). We calculated myocardial contraction fraction (MCF), a marker of LV myocardial shortening, as LV stroke volume divided by LV myocardial volume. The ratio of LVM/LVEDV was used as a measure of LV concentricity to evaluate LV structure. Results: The Table shows MCF, LV concentricity, and indexed LVM (LVMi) stratified by BMI. WT-indexation resulted in a declining LVMi with increasing BMI in both men and women. However, indexation to HT showed an increasing LVMi with higher BMI. BSA-indexation remained consistent across BMI categories in both men and women. MCF decreased and concentricity increased with increasing BMI in both sexes. Conclusion: The association of LVMi with BMI varies by indexation method. In a healthy, community-dwelling cohort, BSA yields “consistent” LVM indexation across BMI categories. However, MCF decreased, and concentricity increased with increasing categories of BMI. These adverse alterations of MCF and concentricity may provide insight into obesity-related LV remodeling, whereas consideration of LVM alone may not. These data lay the groundwork for further outcomes analyses in this population.